Diagnostic microbiology and infectious disease最新文献

{"title":"Evaluation of diagnostic accuracy of the novel Scrub Typhus IgM ELISA Kit.","authors":"Sangitha Jayagandan, Vimal Raj Ratchagadasse, Ferdinamarie Sharmila Philomenadin, Palanivel Chinnakali, Vivekanandan Pillai, Rahul Dhodapkar","doi":"10.1016/j.diagmicrobio.2025.117025","DOIUrl":"10.1016/j.diagmicrobio.2025.117025","url":null,"abstract":"<p><strong>Background: </strong>Scrub typhus (ST) is a rickettsial infection endemic in Southeast Asia, with diagnostic challenges due to its clinical overlap with other febrile illnesses. Due to its accessibility and ease of use, Enzyme-linked Immunosorbent Assay (ELISA) is the widely preferred diagnostic tool.</p><p><strong>Objectives: </strong>This study aims to evaluate the diagnostic performance of the Scrub typhus IgM Microlisa kit (J. Mitra & Co Pvt., Ltd.,) for detecting ST IgM antibodies, using the Scrub Typhus Detect™ IgM ELISA (Inbios International, Inc.) as a reference standard.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using 547 serum samples archived between January 2022 and December 2023. Samples were tested for ST IgM antibodies using the J. Mitra Scrub typhus IgM Microlisa kit (index test) and the Inbios Scrub Typhus Detect™ IgM ELISA kit (reference standard). Sensitivity, specificity, diagnostic accuracy, and likelihood ratios were calculated with 95 % confidence intervals.</p><p><strong>Results: </strong>Of the 247 seropositive samples demonstrated a sensitivity of 87.45 % (95 % CI: 82.74-91.02), specificity of 97.67 % (95 % CI: 95.26-98.87), and diagnostic accuracy of 93.05 % (95 % CI: 90.61-94.9) by index kit. The performance of the index kit was consistent across different durations of fever, with the highest sensitivity observed in samples from patients with a fever lasting >7 days.</p><p><strong>Conclusions: </strong>The J. Mitra Scrub typhus IgM Microlisa kit demonstrates high sensitivity, specificity, and diagnostic accuracy, comparable with that of the reference standard. It offers a reliable alternative for the routine laboratory diagnosis of scrub typhus, facilitating timely diagnosis and management.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117025"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yield of fungal and mycobacterial cultures for operative specimens in orthopedic procedures: A retrospective, observational cohort study.","authors":"Margaret M Cooper, Katherine C Shihadeh, Whitney Miller, Joshua A Parry, Timothy C Jenkins, Michael Wilson","doi":"10.1016/j.diagmicrobio.2025.117049","DOIUrl":"10.1016/j.diagmicrobio.2025.117049","url":null,"abstract":"<p><p>Fungal and mycobacterial cultures are routinely sent on orthopedic operative specimens, but their impact on clinical care is not well established. Processing fungal and mycobacterial cultures is time and labor intensive, associated with significant healthcare costs, and may yield false-positive results due to contamination. The objective of this study was to determine the utility and diagnostic yield of fungal and mycobacterial cultures from orthopedic operative specimens. Patients undergoing surgery by the orthopedic or podiatry service that had operative specimens sent for fungal and mycobacterial cultures from January through December 2022 were included. Fungal and mycobacterial cultures were ordered on a total of 1109 operative specimens in 428 patients. A mean of 2 (standard deviation 1.3) specimens was collected per operative procedure. A microorganism was identified in 34 (3.1 %) of fungal cultures and in no mycobacterial cultures. Fungal microorganisms included yeast (89.7 %), mold (7.7 %) and dermatophytes (2.6 %). Results of the fungal cultures alone led to a change in management for 4 (0.9 %) patients. Results of the mycobacterial cultures did not lead to a change in management for any patient. The diagnostic yield of fungal and mycobacterial cultures on operative specimens in orthopedic and podiatry surgery is low and rarely results in a change in therapeutic management. Standardized approaches for targeted rather than routine use of these cultures should be developed to improve stewardship of laboratory resources.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117049"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating WGCNA and machine learning to distinguish active pulmonary tuberculosis from latent tuberculosis infection based on neutrophil extracellular trap-related genes.","authors":"Tao Wang, Tao Lu, Weili Lu, Jiahuan He, Zhiyu Wu, Ying Lei","doi":"10.1016/j.diagmicrobio.2025.117053","DOIUrl":"10.1016/j.diagmicrobio.2025.117053","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary tuberculosis (PTB) remains a major global public health challenge, with diagnostic delays being a key factor contributing to its high morbidity and mortality. Growing evidence suggests that neutrophil extracellular traps (NETs) are closely associated with PTB pathogenesis. This study focuses on elucidating the role of NETs in PTB and identifying critical diagnostic methods and potential biomarkers.</p><p><strong>Methods: </strong>Weighted gene co-expression network analysis (WGCNA) was employed to identify the three modules most strongly correlated with NETs. Differentially expressed genes (DEGs) from GSE39939 dataset were intersected with module genes to obtain NET-related DEGs. Four machine learning algorithms (LASSO, random forest, RFE, and Boruta) were applied to select feature genes and develop a PTB diagnostic model. Model's performance was evaluated using support vector machine (SVM)-based receiver operating characteristic (ROC) and precision-recall (PR) curves, with validation in the GSE39940 dataset. The optimal algorithm was selected to refine feature genes and construct a miRNA-gene regulatory network.</p><p><strong>Results: </strong>ROC and PR curve analyses revealed that RFE and Boruta algorithms exhibited superior diagnostic efficacy in distinguishing active PTB from latent TB infection (LTBI). Further analysis identified five overlapping high-ranking feature genes (GPR84, SIGLEC10, CCR2, TMEM167A, and GYG1) between the RFE and Boruta algorithms. hsa-miR-1264, hsa-miR-664a-3p, hsa-miR-548e-5p, hsa-miR-4775, and hsa-miR-5056 were predicted to potentially target these genes.</p><p><strong>Conclusion: </strong>RFE algorithm achieves high diagnostic accuracy for PTB and identifies five potential biomarkers (GPR84, SIGLEC10, CCR2, TMEM167A, and GYG1). These findings may provide valuable tools for PTB diagnosis and treatment.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117053"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carriage and infections by multi-carbapenemases producing Enterobacterales.","authors":"Matteo Boattini, Paulo Bastos, Cristina Costa, Gabriele Bianco","doi":"10.1016/j.diagmicrobio.2025.117035","DOIUrl":"10.1016/j.diagmicrobio.2025.117035","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-carbapenemases producing Enterobacterales (MCP-EB) represents a new public health challenge due to their ability to display complex resistance phenotypes.</p><p><strong>Methods: </strong>MCP-EB isolates identified from patients admitted to an Italian Center in the period 2020-2024 were included. Clinical features were collected.</p><p><strong>Results: </strong>Among 3,117 carbapenemase-producing Enterobacterales clinical strains, 31 (1 %) were MCP-EB and were detected from 28 patients. The most common MCP-EB species was Klebsiella pneumoniae (78.6 %; n = 22). Six combinations of two different carbapenemases were observed: KPC+VIM (75 %; n = 21), KPC+NDM (10.7 %; n=3), VIM+NDM (10.7 %; n = 3), KPC+OXA-48-like (3.6 %; n = 1), VIM+OXA-48-like (7.1 %; n = 2), and NDM+OXA-48-like (3.6 %; n = 1). Patients with MCP-EB had a median age of 67 years [IQR 59-73], were predominantly men (57.1 %; n = 16), and a median Charlson Comorbidity Index of 5 [IQR 4-6]. The comorbidities mainly observed were cardiovascular disease (53.6 %; n = 15), chronic respiratory disease (39.3 %; n = 11), and chronic kidney disease (32.1 %; n = 9). Fifty per cent (n = 14) of patients had been hospitalized in the previous 180 days and 75 % (n = 21) had been exposed to antibiotics in the previous 30 days. Median time from admission to MCP-EB specimen collection was 16 days [IQR 10-24] and 28.6 % (n = 8) of patients showed to carry MCP-EB in more than two body districts. Fourteen-day, 30-day, and in-hospital mortality were 10.7 %, 25 %, and 32.1 %, respectively. MCP-EB showed high rates of resistance to all antibiotics tested except aztreonam/avibactam. Patients with MCP-EB infection (35.7 %; n = 10) were treated with combination regimens, mainly including aztreonam plus ceftazidime/avibactam or cefiderocol. Two patients (20 %) had a recurrence of MCP-EB infection and four (40 %) patients did not survive hospitalisation.</p><p><strong>Conclusion: </strong>Clinical features of patients with MCP-EB are common in the hospital population with chronic diseases and showed high mortality rates both in infected and carriers-only patients. Aztreonam/avibactam and cefiderocol could be promising treatment options against MCP-EB infections.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117035"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical profile of patients with indeterminate Xpert rifampin resistance results in a single tertiary level institution.","authors":"Bettina Gabrielle Tenorio, Danielle Josefa Uayan, Kriselle Felicia Lumunsad, Andrea Estuart, Jose Carlos Ruben Javier, Cybele Lara Abad","doi":"10.1016/j.diagmicrobio.2025.117008","DOIUrl":"10.1016/j.diagmicrobio.2025.117008","url":null,"abstract":"<p><p>The significance of indeterminate rifampin resistance (RR) Xpert results remains unclear. Databases from 2016 to 2023 were reviewed, leading to inclusion of 31 cases. Majority were male, newly-diagnosed, symptomatic, and had comorbidities. On culture, ten were rifampin-susceptible, and two rifampin-resistant. Indeterminate results cannot be interpreted, and final TB cultures should be followed-up.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117008"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High diagnostic accuracy of pooled samples analysed with a commercial PCR for detecting MRSA carriage.","authors":"Ditte Bang Oturai, Jonas Bredtoft Boel, Jette Bangsborg, Frederik Emil Mandix, Barbara Juliane Holzknecht","doi":"10.1016/j.diagmicrobio.2025.117031","DOIUrl":"10.1016/j.diagmicrobio.2025.117031","url":null,"abstract":"<p><p>We evaluated the diagnostic accuracy of two Cepheid Xpert MRSA assay generations using pooled samples from 4,519 patients to detect MRSA carriage in a low-prevalence population. High accuracy, including 95 % sensitivity and 99 % specificity was shown for the Xpert MRSA NxG kit. This supports pooled PCR as a resource-efficient method.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117031"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisystem inflammatory syndrome in children (MIS-C) with secondary intestinal cytomegalovirus infection: A case report.","authors":"Chunqiao Li, Tianlei Zhang, Youjun Xie, Rong Wei, Wenbiao Wu","doi":"10.1016/j.diagmicrobio.2025.117038","DOIUrl":"10.1016/j.diagmicrobio.2025.117038","url":null,"abstract":"<p><p>Multisystem inflammatory syndrome in children (MIS-C) constitutes a severe pediatric disorder temporally linked to SARS-CoV-2 infection. Although SARS-CoV-2 may induce cytomegalovirus (CMV) reactivation, MIS-C cases with secondary intestinal CMV infection are exceptionally rare. We describe a pediatric patient with MIS-C treated initially with intravenous immunoglobulin (IVIG) and methylprednisolone, following clinical improvement, sudden high fever and worsening abdominal symptoms occurred. Symptomatic resolution occurred following ganciclovir administration, with CMV infection confirmed by colonic histopathology and metagenomic next-generation sequencing (mNGS).</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117038"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clonorchiasis misdiagnosed as hepatic space-occupying lesion: a case report.","authors":"Peng Son, Fen Yeong Chen, Jun Er Chin Benedick, Ruiling Hui, Simin Guo","doi":"10.1016/j.diagmicrobio.2025.117027","DOIUrl":"10.1016/j.diagmicrobio.2025.117027","url":null,"abstract":"<p><p>Clonorchis sinensis, a zoonotic parasitic infection, is contracted by consuming raw freshwater fish harboring infective larvae of the parasite. C. sinensis infection usually cause damage to the liver and biliary tract system. Chronic infection with C. sinensis can lead to long-term liver and bile duct damage, including hepatic fibrosis, and may increase the risk of developing cholangiocarcinoma (CCA). Nevertheless, a significant portion of infected individuals exhibit either asymptomatic or nonspecific, thereby contributing to a high rate of misdiagnosis. CA19-9 is a tumor-associated antigen that is found in normal glandular epithelium. Elevated levels of CA19-9 serve as an indicator for digestive tract and gynecological diseases and tumors. This case report reveals a 42-year-old female with clonorchiasis presented with elevated CA 19-9 levels, increased FDG uptake in the liver and celiac lymph node on FDG-PET imaging, leading to initial misdiagnosis as cholangiocarcinoma due to the overlap of symptoms with other benign conditions. Clonorchiasis often presents with vague symptoms and lacks sensitive diagnostic methods. During the acute phase, imaging findings may resemble inflammatory or malignant lesions, leading to misdiagnosis and missed diagnosis. To avoid unnecessary interventions, clinicians should consider the patient's overall condition and consult thoroughly to identify any atypical infections.</p>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"113 4","pages":"117027"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a real-time polymerase chain reaction (RT-PCR) assay for simultaneous detection of Helicobacter pylori infection and genetic mutations associated with clarithromycin resistance: A single-center, cross-sectional study from Singapore","authors":"Boran Jiang ,&nbsp;Seok Hwee Koo ,&nbsp;Daphne Shih Wen Ang ,&nbsp;Tiing Leong Ang ,&nbsp;Hui Zi Lee ,&nbsp;Thean Yen Tan","doi":"10.1016/j.diagmicrobio.2025.117131","DOIUrl":"10.1016/j.diagmicrobio.2025.117131","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate diagnosis of <em>Helicobacter pylori</em> (<em>H. pylori</em>), including detection of clarithromycin (CAM) resistance, is important for successful disease management. This study aimed to develop a real-time PCR assay that can simultaneously detect <em>H. pylori</em> infection and screen for point mutations in the 23S rRNA gene responsible for CAM resistance.</div></div><div><h3>Methodology</h3><div>A probe-based assay based on fluorescence melting curve analysis (FMCA) was developed and evaluated in this study. Primers flanking a 173 bp region of the 23S rRNA gene were used for the target amplification. The probe was designed to cross over the mutation hotspots, e.g. A2142G, A2143G, to detect point mutations in the melting stage.</div></div><div><h3>Results</h3><div>A total of 410 gastric tissue biopsies were cultured for <em>H. pylori</em> and concurrently tested by the PCR assay. Among these samples, 407 samples had a valid PCR result. 270 confirmed samples were <em>H. pylori</em>-positive by both PCR and culture. 113 samples were <em>H. pylori</em>-negative by both PCR and culture, and 24 samples were <em>H. pylori</em>-positive by PCR but negative by culture. For susceptibility testing, genotypic results were compared with phenotypic results. In the phenotypic CAM-susceptible group (<em>n</em> = 197), PCR FMCA correctly categorised 95.4 % (<em>n</em> = 188) of the samples into CAM-susceptible genotype. In the phenotypic CAM-resistant group (n = 64), PCR FMCA correctly classified 56 samples as CAM-resistant genotype, equal to 87.5 % accuracy.</div></div><div><h3>Conclusions</h3><div>This PCR assay provides an accurate method to detect <em>H. pylori</em> infection and simultaneously detect mutations in the 23S rRNA gene that are associated with CAM resistance.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 2","pages":"Article 117131"},"PeriodicalIF":1.8,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the QIAstat-Dx® Gastrointestinal Panel 2 for detection of viral, bacterial and parasitic pathogens in fecal swab specimens","authors":"Mélissa Caza ,&nbsp;Cherie Tantichalermsin ,&nbsp;Sherry Gonzales ,&nbsp;Catherine A. Hogan ,&nbsp;David Su ,&nbsp;Jennifer Grant ,&nbsp;Amanda Wilmer","doi":"10.1016/j.diagmicrobio.2025.117129","DOIUrl":"10.1016/j.diagmicrobio.2025.117129","url":null,"abstract":"<div><div>This study evaluates the performance of the QIAstat-Dx® gastrointestinal panel 2 (GIP2) (Qiagen, Spain) for the gastrointestinal pathogens from Fecalswab® specimens (Copan, Italy). For most targets, specimens were tested initially on the Allplex^TM GI assays (Seegene, South Korea). For <em>P. shigelloides</em>, specimens were initially tested on BIOFIRE® GI Panel (BGIP) (bioMérieux, France). Two hundred fifty-nine specimens were tested on the GIP2 (69.5 % archived, 30.5 % prospective). Specimens with discordant results on Allplex^TM GI assays were tested on BGIP or Xpert® Norovirus (Cepheid, USA), while discordant results for P<em>. shigelloides</em> were tested by culture. Consensus results were obtained based on agreement of at least 2 of 3 tests. The percent positive and negative agreement (PPA, PNA) were calculated on a per target basis. Compared to consensus, GIP2 PPA was 95.02 % (95 % CI 91.78 – 97.25 %) and PNA was 99.98 % (95 % CI 99.90- 100.00 %). GIP2 performed well for bacterial and parasitic targets with PPA and PNA &gt;97 %, however had a PPA of 88.3 % (95 % CI 80-81 – 93.61 %) and PNA of 100.0 % (95 % CI 99.75 – 100.00 %) for viral targets. When CT values were examined, QIAstat-dx GIP2 produce similar values to the Allplex^TM GI-viral assay. However, bacterial and parasitic targets on QIAstat-dx GIP2 trends towards lower CT values when compared to the Allplex^TM GI assays.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 2","pages":"Article 117129"},"PeriodicalIF":1.8,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}